POS0568 THE RATIO BETWEEN BIOLOGICAL AND GLUCOCORTICOID USE IN VARIOUS COUNTRIES WORLDWIDE: RESULTS FROM THE METEOR REGISTRY
Authors: I. Nevins, C. Allaart, D. Vega-Morales, L. L. Winchow, A. Chopra, A. M. Rodrigues, T. Huizinga, M. Boers, S. A. Bergstra
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Previously a study in the QUEST-RA database, based on rheumatoid arthritis (RA) patients included between January 2005 and June 2006, has shown that the ratio between biological disease modifying antirheumatic drug (bDMARD) use and glucocorticoid (GC) use strongly differs between countries. Considering the difference in affordability between bDMARDs and GCs, it may be hypothesized, that when less bMDARDs are used, glucocorticoid use increases. <h3>Objectives</h3> To investigate globally, in more recent data, the ratio between bDMARD and GC use, and to assess whether this relates to a country's socioeconomic status (SES). <h3>Methods</h3> Data on bDMARD and GC use between 1-1-2007 and 28-12-2020 were extracted from the METEOR registry: an international database capturing daily clinical practice data from patients with a clinical diagnosis of RA. The ratio between the proportion of patients who had ever used a bDMARD and the proportion of patients who had ever used a GC, with no concomitant bDMARD use, during a total follow up duration of two years (bDMARD/GC ratio) was calculated per country. Univariable linear regression was used to analyze the bDMARD/GC ratios according to publicly available country-level indicators of SES (Worldbank, OECD). <h3>Results</h3> Data from 10,856 patients covering eight countries showed varying proportions of bDMARD use. The number of patients included ranged from 64 (Spain) to 8484 (India). Baseline characteristics varied per country (Table 1) The percentage of patients who used a bDMARD (with or without a GC) during two years follow up ranged from 1% (South Africa, India) to 26% (United States, state of Massachusetts) and for those who used a GC at some time during two years follow up ranged from 19% (Great Britain) to 94% (South Africa). Higher country-level wealth measured in GDP per capita, health expenditure and household net adjusted disposable income were related to a higher bDMARD/GC ratio. For every 10,000 IntI$ increase in GDP per capita, household net adjusted disposable income and health expenditure per capita, the bDMARD/GC ratio (range 0 to 1) was observed to increase by a value of β 0.1 (Figure 1A, 95% CI 0.05;0.1, p&lt;0.05), β 0.2 (Figure 1B, 95% CI 0.08;0.3, p&lt;0.05) and β 0.6 (Figure 1C, 95% CI 0.4;0.8, p&lt;0.05), respectively. <h3>Conclusion</h3> In this analysis based on a worldwide cohort capturing 8 countries, we show that the bDMARD/GC ratio differs across countries. These differences are significantly related to general country-level indicators of level of wealth, where greater wealth went with a higher proportion of patients using bDMARDs and/or a smaller proportion of patients using GCs. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> Isabell Nevins: None declared, Cornelia Allaart: None declared, David Vega-Morales: None declared, Lai-Ling Winchow: None declared, Arvind Chopra: None declared, Ana Maria Rodrigues: None declared, Thomas Huizinga: None declared, Maarten Boers: None declared, Sytske Anne Bergstra Grant/research support from: Received APIRE grant from Pfizer.